Provider Demographics
NPI:1346820073
Name:CAVINESS, STEPHANEE DENISE-GILBERT (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANEE
Middle Name:DENISE-GILBERT
Last Name:CAVINESS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 SPENCER DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4538
Mailing Address - Country:US
Mailing Address - Phone:231-780-3089
Mailing Address - Fax:
Practice Address - Street 1:1902 SPENCER DR
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4538
Practice Address - Country:US
Practice Address - Phone:231-780-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010672831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical